Caldwell_Well Abandonment_20220601

WELL ABANDONMENT RECORD � Far Irrlcrnal Usc t7M Y:
Iltis foim can be used fat single or mullipte wells
1,Wcld Conti-ac6r information: WELL ABANDONMENT DETAILS
Scott Hunt, Jr 7a.Number of trells being;aloandoncd: 19
yYelreeLtmelor Name(oranllo%vwpzEsarrall)aimmilardnguellonhialherpraggcny) Fm nadople ttyerusur or rwo-roarer srrppu- tfels ONLY with My anvue
cyxurnrcnnsa5nharctw,nr�Rit,Tarr am srrtxnlr are.jornr,
4561-A
Ntr IVc11 Conimaor Ccnifrcation Nunrbcr 71t.Approximate volume of water remaining in ivell(s): („aL)
SAHDACCO Inc FOR WATER.SUPPLY NVF.LI.S ONLY:
Company Name %Type of disinfectant used:
2.Well Construction Permit#:,
LLct rnrl�ppG,vhle welt Jeanine fix Cwrr t,t SfA21a,g'urtarce.Lg rciiarr,etct!fbWwn 7d.AmounI of disinfectant ust.41•
3.Well ust-(check Well use):
Water Supply Well: 7e.Scaling materials used(check all that apply):
pAgtfcultlual ❑Mtmicip,Il/Pttblic ❑Natt Ccmcut Grant ® 13c lonitc Chips or Pcllcts
❑Gcoihemmil(Hcalin,,rlCoolino Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑ Dry CLry
❑lndustriaUComnicreial ❑ResidentW Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
❑irri •tion ❑ Speeiatty Grout ❑Grnrel
Non-Water Supply Well: ❑Bentonite Slung ❑ Other(explain under 7g)
❑rilonitoring ❑Recovery
Injection Well: 7f For each material selected above,provide amount of.matedals used:
❑Aquifer Recharge ®Groun duater RentedimiGn
OAgn&r Stotage alxd Recoven' OSalnrity Barrier
❑Aquifer Test ❑Stomntivter Dnifruigc Bentonite.:50 lb per locationlb ,Wtr:gal.
❑E.xretiutental Techttotogy OSubsldettce Coidtol 7g,Provide a brief description of the abandonment prncedurc
❑Geothetnal(Closed Loop) ❑Tracer
Injection borings, abandoned upon completion, betonite from
Meothemtal(Heaiin 'Coolie Return)} Miller Ox Iaiunder7A}
bottom to top. `'.(�. �: n —i - —
4,Date well(s)abandoned: 5/4/22
Sa.Well location:
Unit
LC Hudspeth +or• ,Zl.
v
racllityit7�renor Nmrc Facility iDtt fifapplicablc} R•CeHiltcCat�i_ott:
5891 NC-90, Lenoir, NC 28645 ��LC. l 5/21/2022
Physical Address,City,and Zip SPgmIurc orCcnuScd 1,W¢II Cor clor or Well Qrvrir D,uc
Caldwell Ay mgttlgq this form, I hereby cergfy ninon the wells}eras ahandoned in
Cmniyy Parcel Idcn jf"E66on No.(PIN) aaurrlfrtrce with I i4'C4C 02C.0100.or 2C.0200 r6 e•IJ Consirtiction SlanfkMIN
and that aCopy ofdris record Imu been provided to lire well owner.
5h I atitttdrand loneWde in degreeslminateslsccouds or decimal degrees:
(ifrvall fh4td,ow Litiloup,is snfilcicr7) 9.Site diagram or additional well details:
You may use the back:of this page to provide additional well site darails or well
N W abandounent details. You tuay also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELLMI BEING ABANDONED 4,;L1BAi17TAL INSTRUCTIONS
:IttOtlt r)rtl cnnrtractiart mcarc$!y iJ'rir 0ltwta! rr ,rtutaple i, �r; cv ra,a•,,ntar xuppr�+
nxltn ONLY with dta svuK rntctitrc¢rdorc•r2h i,rthrrttvarir,irio feu n,Lmri ote ferns 10a: Far All Wells.- Submit this furor within 30 days of.compiction of urti
6a.Well ID :Cl-C19 abandonment to the following:
Division of Water Resourem,InformationTrocessing;Unit,
6b.Total well depth: 19 ((y,) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.F r In lection Wells: 41 addition to sending the forni to the addtess to l0a
6c.Borehole diameter;2.25 An.) aboix,also subsuit one copy of ibis form with n 30 days of completion of well
abandomment to the following:
4d.Water teed hc[oR groped surface: (ftJ Division of Water Resources,Undetgrttrud Injection Control Progratu,
1636 Mail Servicc Center,Raleigh,NC 27699 1636
6c Outer casing length(if known): (fL) lt1c.Fnr Writer Sunnis &inleetian Wells; br addition to sending the form to
the address(es) above, also subunit one copy of this form within 30 days of
completion of wdl abandmunent to the county health department of the county
6f.Inner casing/tallying twg,Kb(if lmau•n): (il.)
where abandoned,
6g.Screen length(If known): at.)
Form OW-30 North Carothu Depnnnkm of Pnvironmeot aai Naruml Resotmes-Division of Water Resoum s Reviscd Aaput 2013